Healthcare Provider Details

I. General information

NPI: 1669294666
Provider Name (Legal Business Name): CRYSTAL CLEAR THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MCEWEN RD STE 346
FARMERS BRANCH TX
75244-5276
US

IV. Provider business mailing address

4101 MCEWEN RD STE 346
FARMERS BRANCH TX
75244-5276
US

V. Phone/Fax

Practice location:
  • Phone: 214-531-0721
  • Fax:
Mailing address:
  • Phone: 214-531-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DIAMOND WALKER
Title or Position: OWNER
Credential: L.P.C
Phone: 214-531-0721